It is the policy of this dental practice to inform parents of all procedures contemplated for your child. At each examination appointment, we will identify any dental treatment needed and describe this to you and your child.
Indian Law requires that we obtain your written informed consent for any treatment given to your child as a legal minor.
I fully understand there is a possibility of surgical and/or medical complications developing during or after the procedure.
I further authorize Dr. _______________to perform treatment to preserve the dental health of my child.
I further understand that parents must remain in the reception area for the duration of their child’s visit. However, for the initial visit, that parent will accompany the child to the consultation area. Upon completion of consultation, the parent will be requested to return to the reception area.
I hereby state that I have read and understand this consent form and that all questions about the procedures have been answered in a satisfactory manner. I understand that I have a right to be provided with answers to questions which may arise during the course of my child’s treatment.
I further understand that this consent will remain in effect until such time that I choose to terminate it.
Time: ___________________________________________ AM / PM
Patient’s Name: __________________________________________________
Signature of Parent/Guardian: _____________________________________
Relationship to Patient: ________________________
Among the behaviours that can interfere with the proper provision of quality dental care are: Hyperactivity, resistive movements, refusing to open the mouth or keep it open long enough to perform the necessary dental treatment and even aggressive or physical resistance to treatment, such as kicking, screaming and grabbing the dentist’s hands or the sharp dental instruments.
All efforts will be made to obtain the cooperation of the child dental patients by the use of warmth, friendliness, persuasion, humour, charm, gentleness, kindness and understanding. There are several behaviour management techniques that are used by paediatric dentists to gain the cooperation of child - patients to eliminate disruptive behaviour or prevent them from causing injury to themselves due to uncontrollable movements. The more frequently used paediatric dentistry behaviour management techniques are as follows:
Tell-show-do: The dentist or assistant explains to the child what is to be done using simple terminology and repetition and then shows the child what is to be done by demonstrating with instruments on a model or the child’s or dentist’s finger. Then the procedure is performed in the child’s mouth as described. Praise is used to reinforce cooperative behaviour.
|Initials: ___________________||Date : _______________________|